Healthcare Provider Details

I. General information

NPI: 1982104584
Provider Name (Legal Business Name): ANGELICA MELGOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 PIO PICO DR STE 105
CARLSBAD CA
92008-1951
US

IV. Provider business mailing address

16782 VON KARMAN AVE STE 11
IRVINE CA
92606-2417
US

V. Phone/Fax

Practice location:
  • Phone: 760-500-3325
  • Fax: 858-538-8319
Mailing address:
  • Phone: 855-223-7123
  • Fax: 619-374-7134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number97100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: